Month: April 2022

Food can get microbial contamination anytime and anywhere – while it is being grown, processed, packaged, stored or made.

What is microbial contamination?

Microbes are universal and found everywhere. Some are harmless and some are harmful. All food you eat is prone to microbial contamination at every stage before being eaten. Contaminated food and water when ingested can cause food-borne diseases that can be toxic and infectious in nature. Most common include Staphylococcus and E. coli which can cause food poisoning, diarrhea, kidney failure and other infections. Others like Bacillus, Staphylococcus, Salmonella, Shigella, and Pseudomonas aeruginosa, can cause a host of illnesses.

Where do these microbes come from?

The microbes are either already in the food or added in through the environment during food processing or handling. The possibility of contamination from soil, air and water is very high, including human and animal waste. Hence hygiene of the farm, processing plant and food preparation area is very important. Also stale and improperly stored foods are highly susceptible to bear microbial contamination.

Sometimes the food is already contaminated, for example animal products like meat. When an animal shows slight sign of illness, they are immediately slaughtered and sent to market due to unethical processing practice. Instead of following a quarantine procedure and screening other animals, sick animals are immediately re-purposed and sent to the market to avoid losing money. Hence the adoption and regulation of good manufacturing practice is proving increasingly important.

Instead of following a quarantine procedure and screening other animals, sick animals are immediately repurposed and sent to the market to avoid losing money.

What kind of foods are prone to microbial contamination?

All kinds of food are prone to contamination depending on the way they are produced, processed, stored and handled. These are some major food groups that could be considered most likely for contamination.  

• Processed food and street food:

The most contaminated food are those that require direct handling of the food by hand, for example street food. In one study, all tested street food items from an area in Kathmandu showed they carried some sort of bacterial contamination. Very few food handlers in Nepal receive training in hygiene and understand the source of contamination and the correlation between food handling and illness. Similarly, processed food on the shelves of grocery stores are prone to contamination too. As customers, we opt to equate attractive packaging with food quality. However, it is pertinent on adoption of good manufacturing and processing practices. Without it, there is high likelihood that the food was processed or manufactured in a subpar and unhygienic environment. Especially since there is low surveillance on food, diary and water industries, it poses serious threat to consumer health.

• Fresh vegetables:

Fresh vegetables are prone to get easily contaminated from the soil it’s grown in, water and its environment. Fresh vegetables make a huge part of the Nepali diet. Fresh vegetables and foods that are eaten raw and without peeling gives a huge opportunity for parasitic transmission. That is why cleaning it using clean water thoroughly and properly is very important.

Fresh vegetables that are eaten raw or without peeling can lead to food borne illnesses

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• Water:

Although washing thoroughly can rid of microbial contamination to a certain extent, the interesting thing is that untreated and contaminated water could very well be the source of contamination. Also the water problems in the valley makes it difficult to maintain personal and commercial hygiene. Even bottled drinking water that are marketed as filtered and treated have microbial contamination. In a study, it was reported that among bottled drinking water that were tested 90% of samples showed microbial contamination above acceptable range.

Interestingly microbial contamination can also be present in herbal medicines. Many Nepalese consider ayurvedic medicines as better than allopathic medicines. But herbal medicines have a huge risk for contamination due to inappropriate storage, hygiene at ayurvedic clinics and minimum regulation. Herbal remedies could actually lead to serious health problems instead of relieving current ailments.

How does it affect my health?

Microbial contamination is a serious concern for public health. Food borne diarrheal illness kills more than 2 million people each year worldwide, especially children. Other conditions include typhoid, brucellosis, food poisoning, dysentery and diarrhea, even brain and neural disorders. Food borne illness continues to be the significant cause of morbidity and mortality in Nepal, especially with the proliferation of fast food cafes, restaurants and eating-out culture.
The situation is made worse by the increasing incidence of antibiotic resistance. The increasing incidence of antibiotics fed to animals which when becomes our food, leads to antibiotic resistance in our body over time. In the actual incidence of illness caused by microbial contamination, prescribed antibiotic medications do not work. Secondly the microbes in the food could be a resistant strain that does not respond to our immunity.

The increasing incidence of antibiotics fed to animals which when becomes our food, leads to antibiotic resistance in our body over time. In the actual incidence of illness caused by microbial contamination, prescribed antibiotic medications do not work.

What could be done?

It is important to ensure hygiene and cleanliness during the many stages of food processing and handling to prevent microbial contamination. Two most important concerns include:

• Increased hygiene consciousness: Hygiene consciousness is not big in Nepal, not just with the food producers and handlers, but consumers as well. It may be due to lack of knowledge or negligence there is very little consumer motivation to seek confirmation that their food is treated with regulation. In recent past, there have been instances when food from popular restaurants were found to have faecal contamination . Even with such recorded evidence, the businesses still continue to get multitude of customers. With no pressure from the customers, there is no motivation for government to put regulations in place.
• Good Manufacturing Practices: GMP is an approach that ensures that products produced are consistent in quality. Unhygienic and badly managed manufacturing and processing practice is rampant in Nepal. In a recent study, 43% of raw milk samples collected from milk collection centers were found to have microbial contamination. With the adoption and regulation of Good Manufacturing Practice and certification of businesses, the risk could be mitigated to a large extent.
• Mandatory Food Testing: Food testing establishes the credency of the quality of your product. It is a great way to earn customer trust. While it might be an incredible undertaking for the government to establish mandatory and regular food testing right away, but it will be useful to set safety parameters for all types of food, water, diary, agricultural products.   

How can I make sure that my food at home is protected?

• Wash thoroughly. Cook thoroughly.
• Before handling food, while eating or cooking, wash your hands properly.
• Store food in a cooler environment since high heat environment aides the growth of microbes.
• Don’t drink water that you know is untreated or filtered.
• Ensure that the water that you are using is pure and treated. Inquire about the quality of water that comes to your house.
• Discard and do not consume food that shows any obvious  sign of deterioration or smell.

Condoms are not domestically produced in Nepal, they are procured internationally. But are they quality tested after they have arrived in Nepal?

Condoms in briefSocial marketing has made most of us aware of condom use and the protection it offers. A condom can protect against pregnancy up to 98% of the time. Male condoms are also the only contraceptive method that has proven to provide various levels of risk reduction against sexually transmitted infections. Laboratory studies have shown that latex condoms provide an effective barrier against even the smallest STI pathogens.

With the global AIDS outbreak, internationally backed projects and key drivers like Nepal Contraceptive Retail Sales (CRS), has increased distribution of condoms.

Condom distribution in NepalIn Nepal, treatment coverage for conditions like HIV and STIs is low, so it becomes all the more important to focus on preventive and protective measures like condoms. Before the 1990s, condoms were solely distributed through primary healthcare centers and other frontline health institutions in Nepal, mostly for family planning. With the global AIDS outbreak, internationally backed projects and key drivers like Nepal Contraceptive Retail Sales (CRS), has increased distribution of condoms and also increased discussion around STD and family planning which until then were severely taboo subjects.

Condoms in huge numbers in Nepal

There are many projects that have been working in Nepal for several years to decrease HIV prevalence and encourage family planning. Saath-Saath project distributed 30 million condoms in Nepal from 2011 to 2016 in 33 districts in Nepal. It makes up a total of 100 million condoms distributed by USAID funded projects in Nepal. Similarly, Ghar Ghar Ma Swasthya (Healthy Homes) is a large scale project focussed on improving access to health products like contraceptives in hard to reach areas. With social marketing and behavior change communication, people themselves have become aware of using condoms. It has resulted in a huge demand for condoms.

Where do these condoms come from?

Condoms are not produced domestically in Nepal. Enterprises and nonprofits procure condoms from international manufacturers in countries including China, Malaysia, India, and Thailand. UNFPA, the biggest global buyer of condoms has a prequalified list of manufacturers that fulfill set requirements and qualifications. Even if the condoms are tested pre-shipment and adhere to good manufacturing practices, the condoms are shipped or sent through various methods of transport. Like any other commodity, there is a risk of damage during shipping and storage. In this scenario, it is crucial to conduct third-party testing post shipment. Interestingly in Nepal, there is neither regulation nor evidence about third-party monitoring and testing of imported condoms.  

What is post-shipment condom testing?

Shipping and improper storage could cause wear and tear to condoms. Hence condom testing is carried out to ensure that it adheres to set regulations. While the quantity, labeling, packaging materials, and markings can be checked to see if it is compliant with the requirements of the purchase order, laboratories can test the quality of the condom. These can be many like air burst tests, tensile property tests, dimension tests, leakage tests, package integrity tests, and lubricant tests.

Condom inflation test. There are many types of methods used to check condom quality.

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Why is post-shipment condom testing important?

A condom is a commodity and like any commodity in the market, it is crucial to ensure its quality. It is especially crucial because it is used for family planning and protecting against STIs. A substandard product leads to grave consequences, that range from getting infected from sexually transmitted infections and getting pregnant with an unplanned child. With this, it would seem very necessary that post-shipment quality assurance of condoms is given the highest priority. However, it is unfortunately not the case in Nepal.

A substandard product leads to grave consequences, that range from getting infected from sexually transmitted infections and getting pregnant with an unplanned child.

Is there any evidence of the consequences of substandard condoms?

While there have been international incidences of substandard condoms that were shipped, it is very difficult to gather evidence about the consequences of damaged condoms. It is a very personal and sensitive subject to broach, which makes it difficult to monitor condom use. Also, there are many reasons why condom use still could lead to pregnancy or infections, whether it is improper use, substandard quality or exposure through other areas of the body.

How is the situation internationally?

Each country has its own regulation regarding post-shipment condom testing. UNFPA recommends post shipment testing only when there is any evidence of damage. And the condoms are procured from a pre-qualified list of manufacturers that adhere to the requirements of most recent editions of the WHO/UNFPA specifications. In Nepal, considering the number of condoms that are imported from manufacturers from all over the world and in various shipping and storage conditions, post-shipment condom testing is crucial.

Post-shipment quality testing: Giving it due importance in Nepal

Apart from rising costs, there are many reasons for lack of motivation at various levels about post-shipment condom testing:

• Policy level: While there are national policies that cover post-shipment testing of some food commodities, currently there is no policy that talks about post-shipment monitoring and testing of condoms.
• Procurement level: Companies like Nepal Contraceptive Retail Sales, which has become synonymous to family planning and sexual health in Nepal, has no evidence of conducting post-shipment condom testing. It is crucial that key drivers initiate conversations about condom testing as a crucial part of the process at quality assurance.
• Consumer level: Consumers directly trust condoms with quality and protection. With this assumption, there is low consumer motivation to ask and inquire about the quality of the product they use.
• Lack of testing laboratories: Zest Laboratories is the only internationally accredited company in Nepal well equipped to conduct quality testing of condoms.

What is in your water?

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Let’s talk about water- that comes to your home, that you buy bottled or that comes in a tanker. We equate water with purity. But even clear water can be ridden with contamination. These contaminants are not visible to the eye. Water is used for various reasons like cleaning, drinking, preparing food, irrigation and farming and use of unsafe water can cause a lot of secondary contamination. Even harmless activities like teeth brushing or washing food with contaminated water can cause infection.

Especially in the context of Nepal, where water scarcity and access to drinking water is a big problem in both urban and rural areas, water quality usually takes a back seat, whether it is for public or private water providers or consumers.

In Nepal, water scarcity and inadequate water supply coupled with low surveillance of water quality has lead to widespread delivery and consumption of unsafe water.

What is clean water?

According to WaterAid, minimum quality standards for drinking water dictate that it should be free from disease-causing pathogens, contain no chemicals that may cause health hazards and free from suspended solids, any color, smell, and taste.

The water that comes to my house or that I buy- is it clean and safe?

Depends. In Nepal, water scarcity and inadequate water supply coupled with low surveillance of water quality has lead to widespread delivery and consumption of unsafe water. It is a major public health concern since water-borne diseases are the major cause of morbidity and mortality in Nepal. For accurate analysis, water sample needs to be tested.  

So, why is the water contaminated?

Contamination of sources

Rapid population growth, open defecation, use of pesticides and fertilizers, unsanitary disposal of wastes and other human activities, has caused most of the water sources to become polluted. Whether it is surface water like springs, rivers, and lakes and groundwater from wells and pumps, they are getting polluted due to human activities.

Contaminated water bodies.

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Closely placed water and sewage pipes

In many urban areas, water supply pipes and sewage lines are laid in the same place. Broken sewage and water pipes can cause contamination. Furthermore, contamination of piped water is attributed to intermittent supply of water. During the stoppage of supply, sewage water from the sewage pipe laid parallel or crossing each other or from the surrounding environment with poor sanitation enters into the drinking water pipe.

Inadequate treatment and storage

Improper treatment of water before distribution and poor hygienic storage practice also contribute in the contamination of drinking water. In a study, it was found out of 46 tap water samples, 37 contained microbial contamination and out of 218 samples of treated water, 79 contained microbial contamination.

A water quality test can show the presence of contaminants and will inform appropriate quality measures and treatment actions thats needs to be taken.

What kinds of contaminants are found in water and how does it affect my health?

In the context of Nepal, the following two are high-risk contaminants:

• Microbial contamination:

Microbial contamination is a major cause of public health concern and cause of morbidity and mortality in Nepal. Consumption of drinking water contaminated with human and animal excreta is the major cause of waterborne diseases like diarrhea, dysentery, typhoid fever, hepatitis, and others. It is caused by contamination by pathogenic bacteria, virus, parasites.

Even bottled drinking water that are marketed as filtered and treated have microbial contamination in the recent past. Among many studies conducted, one reported that 90% of samples of bottled drinking water showed microbial contamination above the acceptable range. In another study, 93.7% of open well water samples were found to contain fecal coliforms (bacteria found in intestines of warm-blooded animals like humans). Throughout different studies, whether it is closed piped water, natural spout water, they all were found to have fecal coliforms at different levels.

• Heavy metal and chemical contamination:

Contamination from lead, arsenic, iron, nitrate and ammonia and their presence beyond permissible limits is associated with many health risks. Their presence in water cannot be detected by sight, smell or taste. It can only be detected through lab tests. Increased urbanization and industrialization are to be blamed for an increased level of trace metals.  Especially groundwater like tube wells can have a high likelihood of heavy metal contamination. Acidic rain breaking down soils also releases heavy metals into streams, lakes, rivers, and groundwater.

Heavy metal and chemical toxicity can result in damaged or reduced mental and central nervous function, lower energy levels, and damage to blood composition, lungs, kidneys, liver, and other vital organs. Long-term exposure may result in slowly progressing physical, muscular, and neurological degenerative processes and may even cause cancer. Lead and mercury exact their most devastating toll on the developing brain.

Can these contaminants be removed?

There are many effective and easily available methods for treatment, filtration and disinfection to remove contaminants in water. The main concern is low and infrequent surveillance about water quality. A water quality test can show the presence of contaminants and will inform appropriate quality measures and treatment actions that needs to be taken. These tests can be conducted at çertified and well-equipped laboratories like Zest Laboratories.

Over time, a more stringent approach to implementing water quality has urged private water industries to ensure the quality of their products, however there is still more work to be done.

What about private water industries?

Use of bottled, jar and tanker water, whether for domestic or commercial use, has consistently increased in Nepal. With increased consumption, there should be increased monitoring and surveillance of water quality, however, it is not the case. In a study conducted on bottled mineral water of different brands in the market, a staggering 59.7% of the samples were found to have microbial contamination from fecal matter. In some instances, monitoring revealed that mineral water factories had poor and unacceptable quality maintenance and were sealed off by authorities. Over time, a more stringent approach to implementing water quality has urged private water industries to ensure the quality of their products, however, there is still more work to be done.

Are there laws and policy for water quality in Nepal?

Over years government and stakeholders have given much priority and initiated frequent conversations about water supply and water quality. The government has clearly defined water quality standards and directives for water suppliers to assess water quality. It lists parameters and frequency of testing for various urban, rural, commercial and non-commercial water providers. Water Aid has clear recommendations for water quality testing for water from various sources and mode of supply. Although there are many governing water laws, the problem is limited execution and monitoring of these laws and directives. Various studies have shown evidence of the presence of contaminants in various kinds of water samples. With low surveillance, private and public water providers will not be motivated to put measures in place to ensure water quality or water treatment options. Hence the push needs to come from the government.